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New York rates for HCPCS M0250

Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with COVID-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, second dose

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$434.70 / $450.00 / $450.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.00 / $450.00 / $450.00
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$614.61 / $614.61 / $614.61
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$614.61 / $614.61 / $614.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.73 / $371.73 / $2,169.00
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.00 / $522.90 / $1,176.53
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$522.90 / $782.46 / $1,453.66
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.99 / $602.05 / $1,065.31
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $597.00 / $74,999.25
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.73 / $450.00 / $450.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$397.46 / $552.03 / $1,098.05
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$427.09 / $427.09 / $427.09
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.03 / $427.09 / $1,065.31